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目的探讨脂肪变局灶性结节增生(FNH)的MRI表现与病理的关联,并与连续的在非肝硬化病人切除的其他脂肪瘤进行MRI比较。方法病例包括切除FNH病灶内脂肪变性(n=25)和作为对照组的其他切除脂肪瘤(肝细胞腺瘤和血管平滑肌脂肪瘤,n=34)的病人。根据MR影像将FNH病灶分为3组:典型的FNH且其内无脂肪信号(组1),典型的FNH且其内有脂肪信号(组2),非典型FNH病变者(第3组)。符合诊断标准的其他脂肪性肿瘤也归入到第3组。结果在第1组有9个病灶(15.3%),第2组有4个病灶(6.8%),第3组有46个病灶(77.9%)。第3组包含了12例FNH病灶(26%)和所有其他脂肪性肿瘤。在第3组,病变呈均质性(在T1同相位和T2加权序列上信号强度类似或与邻近的肝组织的信号仅有轻微的不同)并且动脉期增强明显,有脂肪变的FNH病灶为7/12(58%)和其他肿瘤的为3/34(9%)。结论在MR影像上,典型的FNH内有脂肪不应该减少诊断信心。当脂肪瘤在MR影像上表现不典型时,建议必要时进行进一步的肝活检检查。要点①MRI被越来越多地用于评估含脂肪的肝脏病变。②局灶性增生性结节往往含有脂肪灶。③然而,脂肪变性的FNH并不总是能在MR影像上展示典型的脂肪特征。④脂肪变性FNH主要需鉴别的是毛细血管扩张/炎症性肝细胞腺瘤。⑤当脂肪瘤在MRI上表现不典型时,建议行肝脏活检。
Objective To investigate the correlation between MRI findings and pathology of focal fatty nodular hyperplasia (FNH) and to compare with other consecutive lipomas excised from non-cirrhotic patients. Methods Patients included patients with steatosis (n = 25) in the FNH lesion and other resected lipomas (hepatocellular adenoma and angiomyolipoma, n = 34) as controls. FNH lesions were classified into 3 groups according to MR images: typical FNH with no fat signal (group 1), typical FNH with fat signal (group 2) and atypical FNH lesions (group 3). Other fatty tumors that meet the diagnostic criteria are also included in Group 3. Results There were 9 lesions (15.3%) in group 1, 4 lesions (6.8%) in group 2 and 46 lesions (77.9%) in group 3. Group 3 contained 12 FNH lesions (26%) and all other fatty tumors. In group 3, the lesions were homogenous (similar in T1-phase and T2-weighted sequences or slightly different from those in the adjacent liver tissue) and markedly enhanced arterial phase with focal fatty liver lesions of FNH 7/12 (58%) and other tumors were 3/34 (9%). Conclusion In MR images, the presence of fat within a typical FNH should not reduce diagnostic confidence. When lipoma is not typical of MR imaging, it is recommended that further liver biopsy be performed if necessary. Points ① MRI is increasingly used to assess fatty liver disease. ② focal proliferative nodules often contain fat foci. However, steatotic FNH does not always exhibit typical fat characteristics on MR images. ④ FNH fatty degeneration mainly need to identify is telangiectasia / inflammatory hepatocellular adenoma. ⑤ when lipoma atypical on MRI performance, it is recommended to perform liver biopsy.